Towards the problems after the medical reform of China,such as dramatic increase of healthcare expenditure and conflict between doctor and patient,this paper analyzes the tripartite relationships between hospital,insurance supplier and patient from the theoretical and practical aspects,concludes that the non-balanced development of the current relationships is an important reason of the problems,and gives the corresponding countermeasures for reference.

This article summarizes and analysis the rules of acupoint selection in the treatment of dysmenorrhea.Method:Computer retrieval and manual search were combined to look for domestic literature on dysmenorrhea treated by acupuncture and moxibustion in year 2003 to 2011.There were altogether 20 qualified articles,concerning 28 acupoints.The above results showed that in the treatment of dysmenorrhea,the commonly used points are distributed in Ren,spleen meridian of foot-Taiyin,foot Yangming meridian and foot Taiyang meridian.Specific acupoints was the main type for selecting points.

OBJECTIVE To determine the bacterial distribution and resistance of biliary tract infections in China.METHODS Disc diffusion test,MIC test or E-test were used to detect the antimicrobial sensitivity of bacterial isolates from bile specimens.WHONET software was applied for analysis of the bacterial sensitive data from 84 tertiary Mohnarin member hospitals at different area in China from June 1,2006 to May 31,2007.RESULTS A total of 1441 bacterial strains were collected in the survey period,which included 952 Gram-negative strains(66.1%),of which the top three were Escherichia coli(31.0%),Klebsiella pneumoniae(8.4%) and Pseudomonas aeruginosa(7.8%) and 489 Gram-positive strains(33.9%),the top three were Enterococcus faecalis(11.6%),E.faecium(9.5%) and Staphylococcus(7.4 %).Susceptibility results showed that the resistant rates of E.coli and K.pneumoniae to three generation cephalosporins and quinolones were 25.9-70.0%,17.9-44.8% and 66.9-70.9%,34.6-40.0%,respectively,which were comparable with the results of overall bacteria collection.The resistant rates of P.aeruginosa to imipenem and cefoperazone/sulbactam were 37.5%,13.8%,and the detection rate of meticillin-resistant Staphylococcus aureus(MRSA) from bile samples was higher than the results of overall bacteria collection.Vancomycin-resistant Enterococcus(VRE) were rare.CONCLUSIONS Gram-negative bacilli are still the predominant pathogens in biliary tract infections;the overall bacterial resistance is severe.MRSA is increasing.Prudent application of antibiotics in biliary tract infections needs to be emphasized.

Objective To observe the effectiveness of botulinum toxin A (BTXA) in the treatment of small sample patients with acute acquired concomitant esotropia. Design Retrospective case series. Participants 6 patients (3 female and 3 male) with acute acquired concomitant esotropia aged 6 to 34 years. Methods All the patients were received 2.5 units of BTXA injected into the bilateral medial rectus muscles once under electromyographic control. They were performed alter prism-cover test,synoptophore and stereoscopic charts test. Main Outcome Measures The alignment of eyes and binocular vision. Results The follow-up of patients was 4 to 39 months. The pre-injection angle of deviation was 43.3?1.0△; the angle of deviation at the last follow-up was 3.3?8.2△,and 5 patients achieved alignment. In pre-injection,one patient had distance stereopsis,2 patients had near stereopsis with 600 seconds and 40 seconds; after injection,5 patients demonstrated distance and near stereeopsis (3 patients 40 seconds,1 patient 60 seconds,and 1 patient 200 seconds). Conclusion This small sample study shows that BTXA injection is effective alternative in treating acute acquired concomitant esotropia.

Objective To observe the effect of ligustrazine hydrochioridc(LHC) injection on TGF-β1 -induced proliferation and type IV collagen secretion in the human mesangial cells(HMCs). Methods The interstitial fibrosis in kidney disease was mimicked by inducing proliferation and type IV collagen secretion in HMCs with TGF- β1. The experiment was divided into 5 groups: blank, control, low, medium, and high(10, 30, and 100 μg/ml)ligustrazinc hydrochloride groups. MTT method was adopted to examine the proliferation and inhibition rate of HMCs. Enzyme-linked immunosorbent assay was used to determine the production of type IV collagen in cultured HMCs. Results LHC at high concentration (100 μg/ml) significantly inhibited the proliferation of HMCs (P<0. 01). LHC also inhibited the production of type IV collagen, with the significant inhibition found when at the concentration of 100 μg/ml (P

Abstract: Objective To understand the current situation of lung function and nasal inflammation of students from different places of origin, and to explore the possible relationship between air pollutants and lung function and inflammatory factors of healthy college students. Methods A self-designed questionnaire was used to investigate 253 healthy college students, including their basic personal information, the origin of students, and their living environment, then their lung functions were tested, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak expiratory flow (PEF). Furthermore, according to the air quality of the region of origin, 60 students from areas with good air quality and 30 students from areas with poor air quality were selected. Nasal inflammatory factors (IL-6 and TNF-α levels) were detected before (July 12, 2019) and after summer vacation (August 27, 2019) to analyze the impact factors on lung function in healthy college students and the level of nasal inflammatory markers after short-term differential exposure to air pollutants. Results The univariate analysis of the questionnaire survey showed that the lung function of healthy college students was influenced by urban-rural distribution, air quality of students' origin, and height. Multivariate analysis found that compared with urban healthy college students, the FVC and FEV1 of rural students increased by 0.346 L and 0.322 L respectively (P<0.05). In addition, for each decrease in the grade of air quality of students' origin, FEV1 and PEF decreased by 0.193 L and 0.687 L/s respectively (P<0.05). After differential exposure to air pollutants during the holiday, healthy college students from areas with poor air quality had higher levels of the nasal mucous membrane inflammatory marker TNF-α than those from areas with good air quality (P<0.05). Conclusions The lung function of healthy college students is affected by urban-rural distribution and the air quality of their region of origin, and the short-term differential exposure to air pollutants leads to changes of nasal inflammatory factors in young healthy individuals.

Objective To compared the electrophysiological features in peripheral vertigo and central vertigo. Methods The electronystagmograph ( ENG ) and brainstem auditory evoked potentials ( BAEP ) were applied in peripheral vertigo group(85 cases) and central vertigo group(61 cases).Result ENG abnomal was in 67 cases (78.8%) in peripheral vertigo group.Overshoot or undershoot of dysmetria test was in 6 cases ( 7.1%);spontaneous nystagmus was in 5 cases(5.9%);abnormal of gaze test was in 16 cases(18.8%); eye tracking test typeⅠwas in 42 case(49.4%), typeⅡwas in 17 cases(20.0%), and typeⅢwas in 8 cases(9.4%); bilateral asymmetry of optokinetic nystagmus test was in 19 cases(22.4%);positioning nystagmus was in 51 cases(60.0%);abnormal of cold and hot test was in 31 cases(36.5%).ENG abnomal was 42 cases(49.4%) in central vertigo group.Overshoot or undershoot of dysmetria test was in 19 case(31.1%);spontaneous nystagmus was in 13 cases (21.3%);abnormal of gaze test was in 23 cases(37.7%);eye tracking test typeⅠwas in 35 cases(57.4%), typeⅡwas in 13 cases(21.3%), and typeⅢwas in 8 cases(13.1%);bilateral asymmetry of optokinetic nystagmus test was in 33 cases(54.1%); positioning nystagmus was in 2 cases(3.3%); abnormal of cold and hot test was in 6 cases(9.8%).Compared with peripheral vertigo group, the abnormal rates of optokinetic nystagmus test, gaze test, eye tracking test, optokinetic nystagmus test in central vertigo group were significantly increased, and the abnormal rates of positioning nystagmus, cold and hot test in central vertigo group were significantly decreased (all P<0.05). There were 32 cases(37.6%) in peripheral vertigo group with BAEP abnormal, and 31 cases(50.8%) were in central vertigo group with BAED abnormal.Compared with central vertigo group, the latency ofⅠwave andⅠ-Ⅲwave latency delayed in peripheral vertigo group were significantly increased, the latency ofⅤwave andⅠ-Ⅴwave latency delayed were significantly decreased ( all P<0.05 ) .Conclusions There are high sensitivity of optokinetic nystagmus test, gaze test, eye tracking test, optokinetic nystagmus test of ENG to the diagnosis of central vertigo. There are high sensitivity of positioning nystagmus, cold and hot test to the diagnosis of peripheral vertigo.The positive rate of BAEP is relatively lower, but it can provide objective foundation for location of vertigo patients.

Objective To evaluate the accuracy of stoke volume variation (SVV) determined using FloTrac/Vigileo and Picco-plus technologies in prone position for assessment of the blood volume in the patients undergoing spine surgery,Methods Forty-three ASA physical status Ⅰ-Ⅲ patients of both sexes,aged ＞ 18 yr,weighing 40-100 kg,scheduled for elective posterior approach to lumbar spinal fusion or scoliosis surgery were studied.After induction of anesthesia,a volume expansion was performed in supine and prone positions.Hydroxyethyl starch 130/0.4 sodium chloride injection 5 ml/kg was rapidly infused intravenously over 10 min to carry out the test for fluid responsiveness.Picco-plus and FloTrac/Vigileo systems were simultaneously applied in every subject to measure SVV (SVVP and SVVF).Positive fluid responsiveness was defined as the changing rate of stroke volume index ≥ 10％ as measured by using Piccoplus system.The patients were divided into response group (Rs group) and non-response group (NRs group) according to the changing rate of stroke volume index ≥ 10％ and ＜ 10％.The receiver operating characteristic (ROC) curve for SVV was plotted,and the diagnostic threshold,area under the ROC curve and 95％ confidence interval (CI) were calculated.Results Forty-one patients were included for analysis in this study.In supine position,the area under the ROC curve for SVV in predicting the fluid responsiveness was 0.740 (95％ CI:0.568-0.913),the diagnostic threshold was 12％,and the sensitivity and specificity in determining fluid responsiveness were 86％ and 54％,respectively,for SVVF,and the area under the ROC curve was 0.637 for SVVP.In prone position,the area under the ROC curve was 0.451 for SVVF,and 0.634 for SVVP.Compared with Rs group,the baseline value of SVVFwas significantly lower,and no significant change was found in the other hemodynamic parameters before volume expansion in supine position in NRs group.There was no significant difference in the hemodynamic parameters before volume expansion in prone position between the two groups.Conclusion SVV determined by using FloTrac/Vigileo and Picco-plus systems in prone position can not accurately assess the blood volume in the patients undergoing spine surgery.

Objective:To investigate the effect of HLA genetic susceptibility and NK cell receptors and immune response on the occurrence and development of the Cervical cancer.Methods: Select the 200 patients confirmed by the pathological biopsy in our hospital from January 2013 to January 2014 as the observation group.At the same time,randomly select the 200 healthy women as the control group.Both of them blood 2 ml peripheral blood,sample the cervical cell from the observation group.Having the cytological ob-servation and the DNA′s probe of the HPV,observe two group′s HPV infection rates and HLA′s parting.Results: The HPV infection rates of the observation group is 91%,and the rates of the control group is 16%.The differences between them were all significant(P<0.05).The HLA-KIR*1003,HLA-KIR*14,HLA-KIR*17,HLA-KIR*02,HLA-KIR*12 distribution frequency of the observation group are 41%,39%,35%,15%,53%.The HLA-KIR*1003,HLA-KIR*14,HLA-KIR*17,HLA-KIR*02,HLA-KIR*12 distribution frequency of the control group are 18%,15%,14%,52%,89%.The differences between them were all significant ( P<0.05).Among them The HLA-KIR*1003, HLA-KIR*14, HLA-KIR*17 distribution frequency of the observation group are significantly higher than the control group, HLA-KIR*02 , HLA-KIR*12 distribution frequency of the observation group are significantly lower than the control group.Conclusion:During the occurrence and development of the Cervical cancer,the HLA-KIR*1003,HLA-KIR*14,HLA-KIR*17 may be the risk factors for the Cervical cancer;the HLA-KIR*02,HLA-KIR*12 may be the protective factors for the Cervical cancer.

Recent work has shown that nitric oxide (NO) induction by nitric oxide synthase(NOS) is the physiological mediator of bone cell function and demonstrated that it may be possible to exert differential effects on osteoblast (OB) and osteoclast (OC) activity in vivo. The proinflammatory cytokines, such as tumor necrosis factor-? (TNF-?), interleukin-1? (IL-1?), interferon-? (IFN-?), will stimulate bone resorption by NOS-induced low levels of NO. These findings confirm NO as a potentially important osteoblast-osteoclast coupling factor, indicating that cytokine-induced NO was largely responsible for the mechanisms of osteoporosis. Pharmacological modulation of NO may therefore represent a new approach in the treatment of bone diseases characterized by increased bone resorption, such as osteoporosis (OP).